Distinct white matter alterations following severe stroke: Longitudinal DTI study in neglect.

Umarova, Roza M; Beume, Lena; Reisert, Marco; Kaller, Christoph P; Klöppel, Stefan; Mader, Irina; Glauche, Volkmar; Kiselev, Valerij G; Catani, Marco; Weiller, Cornelius (2017). Distinct white matter alterations following severe stroke: Longitudinal DTI study in neglect. Neurology, 88(16), pp. 1546-1555. Lippincott Williams & Wilkins 10.1212/WNL.0000000000003843

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OBJECTIVE To distinguish white matter remodeling directly induced by stroke lesion from that evoked by remote network dysfunction, using spatial neglect as a model. METHODS We examined 24 visual neglect/extinction patients and 17 control patients combining comprehensive analyses of diffusion tensor metrics and global fiber tracking with neuropsychological testing in the acute (6.3 ± 0.5 days poststroke) and chronic (134 ± 7 days poststroke) stroke phases. RESULTS Compared to stroke controls, patients with spatial neglect/extinction displayed longitudinal white matter alterations with 2 defining signatures: (1) perilesional degenerative changes characterized by congruently reduced fractional anisotropy and increased radial diffusivity (RD), axial diffusivity, and mean diffusivity, all suggestive of direct axonal damage by lesion and therefore nonspecific for impaired attention network and (2) transneuronal changes characterized by an increased RD in contralesional frontoparietal and bilateral occipital connections, suggestive of primary periaxonal involvement; these changes were distinctly related to the degree of unrecovered neglect symptoms in chronic stroke, hence emerging as network-specific alterations. CONCLUSIONS The present data show how stroke entails global alterations of lesion-spared network architecture over time. Sufficiently large lesions of widely interconnected association cortex induce distinct, large-scale structural reorganization in domain-specific network connections. Besides their relevance to unrecovered domain-specific symptoms, these effects might also explain mechanisms of domain-general deficits in stroke patients, pointing to potential targets for therapeutic intervention.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > University Psychiatric Services > University Hospital of Geriatric Psychiatry and Psychotherapy

UniBE Contributor:

Klöppel, Stefan


600 Technology > 610 Medicine & health




Lippincott Williams & Wilkins




Katharina Klink

Date Deposited:

15 Sep 2017 11:19

Last Modified:

15 Sep 2017 11:19

Publisher DOI:


PubMed ID:






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